Healthcare Provider Details

I. General information

NPI: 1063448025
Provider Name (Legal Business Name): BRIAN W.J. MCCARTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4982 HYLAN BLVD
STATEN ISLAND NY
10312-6399
US

IV. Provider business mailing address

1407 W 6TH ST FL 3
BROOKLYN NY
11204-4802
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-6200
  • Fax: 718-967-6314
Mailing address:
  • Phone: 718-256-1057
  • Fax: 718-256-4912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number208767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: